Portfolio Flashcards
“What is clinical audit?”
Clinical audit is a quality improvement process that seeks to improve patient care and outcomes by comparing clinical practice to a set standard. It also extends to the reviewing of any changes made. It is examines how well an institution or a practitioner is performing against set standards.
The audit cycle
- Identifying a problem
- Identify a standard
- Collect data on current practice
- Assess conformity of clinical practice with the standard
- Implementing change
“Tell us about an interesting audit that you did”
An interesting audit that I led, designed and implemented was an operation note audit. As I was looking through previous operation note audits within the department I noticed that a common recommendation was the use of an electronic system would potentially improve documentation and compliance to the standards. The hospital that I was working in was in the process of switching to an electronic patient record system.
I collected data from 20 operation notes and compared them to Good Surgical Practice standards and got a compliance rate of
How many electives and emergency cases?
After the implementation of the EPR system coupled with staff training I re-audited another 20 operation notes and again compared them to the standard and got a compliance rate of
The result of the audit.
The results of my audit were selected presented at a regional conference UPRAS 2017
“Why are audits important?”
- One of the key pillars of of clinical governance
- Ensures that quality of care is maintained to a set standard
- Enables the identification of problems and the implementation of change
- It encourages services to make better use of resources and results in better efficiency.
- Lastly it’s a process that plays a key part in the training of junior doctors in order for them appreciate and gain skills in management therby investing in their profession.
“What is the difference between audit and research?”
Fundamentally the difference between research and audit is that research looks at new ways of doing things and can be used to create new standards of care. It looks at what best practice is, whether new treatments work and why. Essentially, It looks at whether we are doing the right things.
Audit on the other hand looks at current practice and compares it to current standards. It looks at whether we are doing things right. It is examines how well an institution or a practitioner is performing against set standards and is able to introduce change relatively quickly.
Audit Research
Continuous process One off
Data gathering Experimentation
Compliance with standards Based on a hypothesis
“Tell us about your research experience?”
During my undergraduate years I really desired to improve my research skills so I used one of my summer holidays to volunteer as a research assistant with the university. I was selected to do the job on a competitive basis because of my keen interest and enthusiasm which was the feedback I received from the consultant who interviewed me. I contributed to translation research into germ cell tumours looking at the relationship between gene expression and patient outcome. I created a data collection system and liaised with secretaries to obtain patient notes collecting the relevant data regarding tumour characteristics and evidence of lung toxicity as a result of the chemo received. I then relayed my findings with the biomedical scientists and other researchers who were able to use the data to carry out genetics studies to identify which patients were at greater risk of developing bleomycin toxicity. The data I collected I was then able to use to carry out an audit as part of a research project later in the year.
Being able to contribute to such research helped me to develop team working skills by communicating with a wide range of professionals as well as planning and time management. Through the audit process I gained knowledge of how to carry out a literature review and critically appraise. Overall I left with a greater understanding of the research process as a whole.
In future I plan to attend courses to further improve my critical appraisal skills which will help me to carry out more clinical projects with a greater level of independence.
“Why is research important?”
Research aims to drive medical advancement by developing knowledge that can be translated into better patient care. Research can benefit patients by improving treatments and procedures.
- Improves the trusts reputation and attracts high quality staff
- Patients can get early to latest technologies in trusts that are actively involved in research.
- Enables doctors to understand the evidence on which decisions are based with regards to treatments and procedures they are using in everyday practice.
- Ensures patients are receiving the best care possible.
Definition of clinical governance
It’s a quality assurance process that ensures standards of care are maintained and improved and that the NHS is accountable to the public.
7 pillars of clinical governance
Clinical Effectiveness & Research - doing the right thing, to the right person at the right time and in the right place Audit Risk Management - Minimising risks to patients and staff and to learning from mistakes and near misses Education & Training - To keep up to date Patient and Public Involvement - Patients having a say in their care through PALS and feedback questionnaires Using Information & IT - Managing patient data Staffing and Staff Management - Staffing levels - Working conditions
“What is your experience of clinical governance?”
Clinical effectiveness - new guidelines Audit - participated in 4 audits Risk Management - seek help - Double check things Education & Training - Teaching I’ve done - Attend courses Patient/Public Involvement Using information & IT - EPR Training Staffing & Management
“Tell Me About Yourself”
“Talk Me Through Your CV”
My name is Sade and I am currently on a year out of training during which I spend most of my time doing locum work in Plastic Surgery and A&E. I graduated from the University of Leeds in 2015 and have trained in the same region since then. During my foundation years I experienced a wide variety of specialties such as respiratory medicine, trauma and orthopaedics, old age psychiatry, Accident and emergency, acute medicine and Plastic Surgery. My last rotation was the one I enjoyed the most due to the very practical nature of the job and it is the reason why I have decided to pursue a career in Surgery.
Clinical
- History, examination & procedural skills
- Trauma & Ortho
- A&E
- Courses
During my foundation years I have gained confidence in history taking and basic procedures such as cannulation and urethral catheterisation. Through my trauma and orthopaedic attachment I gained a good level of knowledge regarding the management of trauma cases. I also used the opportunity to learn new skills such as how to perform a fascia iliac block to help in the post operative management of pain in fractured neck of femurs. My A&E attachment greatly built my confidence in diagnosing and managing the acutely unwell patient. It provided me with excellent training in how to stay calm and organised under pressure which has proven extremely useful during On-Call shifts. I have also attended a number of courses to help gain new surgical skills.
Academic
- Research
- Teaching
During my undergraduate years I really desired to improve my research skills so I used one of my summer holidays to volunteer as a research assistant with the university. I contributed to translation research into germ cell tumours looking at the relationship between gene expression and patient outcome.
I have also thoroughly enjoyed developing my teaching skills and have set up and organised a number of teaching sessions during my foundation years not just for medical students but for more senior colleagues also.
Management
- Audit
- Clinical Guidelines
Over the last two years I have also played an active role in audit and service improvement. I have completed two, one of which is a closed loop audit in which a change was implemented and re-audited. I was the lead for both of these audits.
“What is your biggest achievement?”
My biggest achievement has been getting admission to medical school. This is a challenge that of course all trainees have had to go through but the reason why it was such a big one for me was because I came through a very unconventional route. I had to apply competitively through a a foundation programme. There were 90 students all wanting a place a Leeds Medical School and only 20 places on offer. Majority of the other students had already applied to medicine previously and appeared to have the upper hand whereas I had no prior experience. Coupled with fact that I was a young person who had just left the foster care system I had a number of personal and financial challenges I had to overcome on top of my studies. Despite all this I did secure a place.
I am particularly proud of this achievement because I had to work extremely hard to even be considered for an interview ahead of other more experienced candidates. I am also proud because it has meant I can use my experiences and achievements to inspire young people who also came from a disadvantaged or care background to know that careers like this are not out of their reach.
“Why Surgery?”
“What do you like most about Surgery”
Clinical
- Practical, able to work with your hands to produce an immediate result
- Work with people of all ages and a variety of specialties
Academic
- Good opportunities for teaching
Personal
- Enjoy working under pressure
Surgery is a career that’s I have developed a great interest in whilst working in Plastic Surgery.
From a clinical perspective it is a very practical field in which one gets to really work with their hands to produce immediate results. During my attachment I thoroughly enjoyed performing minor operations in trauma cases and the gratification that came from turning a nasty wound into a clean and neat one.
I also enjoyed the fact that you can work with all ages which adds variety to the job. One minute I could be repairing a the nailbed of a 1yr old and the next treating a pretibial haematoma on a 75yr old.
From an academic perspective, I like the fact that there is ample opportunity to teach and pass skills I have gained to others. This is something I really enjoy and have recently set up suturing workshops for medical students.
And personally I enjoy the buzz of working under pressure and dealing with acute trauma cases.
“What have you done to demonstrate your interest in Surgery”
Locum work - able to gain more clinical experience
CPD Courses - able to learn new skills
Attending Conferences - able to hear from professionals in the field, strengthened my desire to pursue the speciality
MRCS Exam - to progress
“Tell us about your teaching experience”
I have gained a great deal of teaching experience during my foundation years.
- Informal - tutorials
- Workshops - FY1 Crash Course
- Set up suturing workshop for medical students
- Set up an induction section for CST while still an FY2
I attended a teach the teacher course as part of my training. Delivered a presentation on burns assessment and a practical session on IO insertion. I learnt a effective and structured way of teaching people skills.
The feedback I’ve received has been extremely positive stating that majority of my colleagues felt the sessions were useful and meant that they were better informed to start their jobs.
I hope to be involved in teaching on a larger scale and I feel there aren’t enough opportunities for undergraduates and foundation year doctors to learn surgical skills which is something I plan to contribute towards in future.
